- Email: [email protected]
POST-STROKE COGNITION CORRELATES BETTER WITH REGIONAL BRAIN VOLUME THAN WHITE MATTER HYPERINTENSITY VOLUME
Poster Presentations: P2 Table 1 Participant Characteristics
Age Mean (SD) 45-54 55-64 65-74 75-84 85+ Race Non-White White Gender Male Female Education, yrs Mean (SD) <12 yrs eGFR Mean (SD) <15 15-<30 30-<45 60-<70 70+ Diabetes Hypertension Stroke/TIA history Depression history
CKD (n ¼ 109)
Non-CKD (n ¼ 23)
P
68.5 (9.87) 8 (7.3%) 33 (30.3%) 35 (32.1%) 30 (27.5%) 3 (2.8%)
63.3 (11.27) 6 (26.1%) 7 (30.4%) 5 (21.7%) 4 (17.4%) 1 (4.3%)
0.0281 0.0959
18 (16.5%) 91 (83.5%)
5 (21.7%) 18 (78.3%)
.
58 (53.2%) 51 (46.8%)
11 (47.8%) 12 (52.2%)
.
0.5483
0.6385
14.0 (2.85) 11 (10.2%)
15.5 (1.97) 1 (4.3%)
0.0156 0.3782
30.0 (9.17) 9 (8.3%) 36 (33.0%) 64 (58.7%) 0 0 53 (49.1%) 103 (95.4%) 14 (12.8%) 38 (35.2%)
85.0 (15.47) 0 0 0 3 (13.0%) 20 (87.0%) 3 (13.0%) 9 (39.1%) 2 (8.7%) 9 (39.1%)
<.0001 <.0001
0.0015 <.0001 0.5796 0.8511
Statistics reported are mean (standard deviation) or N (%). (ROIs) from Freesurfer, white matter hyperintensity (WMH) fraction, cortical (> 1 cm) and subcortical infarcts and micro-hemorrhages were assessed from structural MRI scans (T1, FLAIR, and GRE sequences on 1.5T). We tested for differences between CKD and non-CKD using linear regression for WMH fraction, Fisher’s exact test for infarcts, and negative binomial regression for counts of definite micro-hemorrhages. Adjusted models controlled for age, race, sex, education, and diabetes. Results: Participant characteristics are described in Table 1. Gray matter volume was lower in CKD vs. non-CKD ppts in ROIs that are associated with cerebrovascular disease (frontal lobes) and Alzheimer’s disease (temporoparietal regions) (p<0.05). Global cortical volume was also significantly lower in CKD vs. non-CKD ppts (p<0.05). We also found higher mean WMH fraction in CKD participants (unadjusted p¼0.03, adjusted p¼0.17). Ten (9%) CKD ppts had > 1 small cortical or > 1 subcortical infarct vs. none in non-CKD (p¼0.14). Twenty-three CKD ppts had 57 definite micro-hemorrhages, compared to 9 in 3 non-CKD ppts, but this difference was notstatistically significant. Conclusions: We found significantly lower gray matter volume in ROIs associated with both AD and vascular disease and greater WMH burden in CKD vs. non-CKD ppts. Prevalence of ppts with > 1 cortical or > 1 subcortical infarct and prevalence of ppts with micro-hemorrhages were also higher in CKD vs. non-CKD ppts, although these differences were not statistically significant. These results suggest that CKD is associated with structural changes in the brain that reflect both neurodegenerative and vascular etiologies. Further sutdy is needed to understand the correlation of the structural abnormalities with cognitive function. Sponsor:NIA AG037551-01A3. P2-080
POST-STROKE COGNITION CORRELATES BETTER WITH REGIONAL BRAIN VOLUME THAN WHITE MATTER HYPERINTENSITY VOLUME
Amy Brodtmann1, Emilio Werden1, Qi Li1, Laura Bird2, David Darby3, Toby Cumming1, 1The Florey Institute for Neuroscience and Mental Health,
P499
Melbourne, Australia; 2The Florey Institute, The Florey Institute for Neuroscience and Mental Health, Melbourne, Australia; 3The Florey Institute, The Florey Institute for Neuroscience and Mental Health, Parkville, Australia. Contact e-mail: [email protected] Background: Results from several longitudinal community studies suggest that white matter lesions or hyperintensities (WMH) are associated with cognitive and functional impairment in dementia and stroke patients. Further evidence from the Framingham cohort suggests that WMH volume and total brain volume are also associated with increased risk of stroke. However, the association between WMH volume, regional brain volumes and cognition after stroke have not been studied in detail. The Cognition And Neocortical Volume After Stroke (CANVAS) study is a prospective longitudinal study looking at cognition and brain volume after stroke. We examined the WMH, hippocampal and amygdaloid volumes in the first 50 patients and correlated with tests of memory and attention. Methods: Patients were included if they had no history of cognitive decline, and were tested within 30 days of acute ischemic stroke. Patients were screened for history of cognitive Isotropic 1 mm MPRAGE images were acquired on a Siemens Trio 3T MRI scanner. Images were processed using Freesurfer V 5.1 with default settings, generating automated measures for thalami and amygdalae. Hippocampal and total brain WMH volumes were calculated via manual tracing. Regional volumes were calculated as ipsi-, contralesional and averaged. Patients completed tests of memory (Hopkins Verbal Learning Test-Revised (HVLT): total, delay, retention, and recognition z scores) and attention (CogState, detection, and identification reaction time, one back learning test (OBK) percent correct). Correlation analysis was performed for cognitive scores, WMH volume and regional volumes. Results: 50 patients aged 68.8611.6 years (mean years of education 13.364.0, NIHSS 3.863.1, days to testing 22.3) were included. Performance on the HVLT was below expected norms: mean total z-score -0.88, delayed -1.06. WMH volume was not significantly correlated with analysed cognitive measures. Hippocampal and amygdaloid volume was more strongly correlated with immediate recall and recognition memory than delayed recall - see table. Performance in OBK was significantly correlated with amygdala volume but not with hippocampal volume. Reaction times correlated most strongly with ipsilesional hippocampal volume: detection r¼-0.316, p¼0.039; identification r¼-0.390, p¼0.010. Conclusions: Memory performance is impaired in stroke patients in the first month following stroke, even in people with no history of cognitive impairment. Hippocampal and amygdaloid volumes correlated more closely than WMH with memory and attention in the early post-stroke period. Table Hippocampal volume
r-value
p-value
HVLT immediate recall HVLT recognition memory HVLT delayed recall One back learning
0.346 0.331 0.190 0.240
0.016 0.023 0.19 0.212
Amygdala volume
r-value
p-value
HVLT immediate recall HVLT recognition memory HVLT delayed recall One back learning
0.322 0.432 0.220 0.358
0.024 0.002 0.130 0.012
P2-081
COGNITIVE IMPAIRMENT IN MODERATE CHRONIC KIDNEY DISEASE: THE BRAIN IN KIDNEY DISEASE (BRINK) STUDY
Anne M. Murray1, David S. Knopman2, Rebecca C. Rossom3, Brooke Heubner4, David Tupper5, Elizabeth Amiot1, 1Minneapolis Medical Research Foundation, Minneapolis, Minnesota, United States; 2Mayo Clinic, Rochester, Minnesota, United States; 3HealthPartners, Bloomington, Minnesota, United States; 4Chronic Disease Research Group, Minneapolis, Minnesota, United States; 5Hennepin County Medical Center, Minneapolis, Minnesota, United States. Contact e-mail: [email protected]
Age Mean (SD) 45-54 55-64 65-74 75-84 85+ Race Non-White White Gender Male Female Education, yrs Mean (SD) <12 yrs eGFR Mean (SD) <15 15-<30 30-<45 60-<70 70+ Diabetes Hypertension Stroke/TIA history Depression history
CKD (n ¼ 109)
Non-CKD (n ¼ 23)
P
68.5 (9.87) 8 (7.3%) 33 (30.3%) 35 (32.1%) 30 (27.5%) 3 (2.8%)
63.3 (11.27) 6 (26.1%) 7 (30.4%) 5 (21.7%) 4 (17.4%) 1 (4.3%)
0.0281 0.0959
18 (16.5%) 91 (83.5%)
5 (21.7%) 18 (78.3%)
.
58 (53.2%) 51 (46.8%)
11 (47.8%) 12 (52.2%)
.
0.5483
0.6385
14.0 (2.85) 11 (10.2%)
15.5 (1.97) 1 (4.3%)
0.0156 0.3782
30.0 (9.17) 9 (8.3%) 36 (33.0%) 64 (58.7%) 0 0 53 (49.1%) 103 (95.4%) 14 (12.8%) 38 (35.2%)
85.0 (15.47) 0 0 0 3 (13.0%) 20 (87.0%) 3 (13.0%) 9 (39.1%) 2 (8.7%) 9 (39.1%)
<.0001 <.0001
0.0015 <.0001 0.5796 0.8511
Statistics reported are mean (standard deviation) or N (%). (ROIs) from Freesurfer, white matter hyperintensity (WMH) fraction, cortical (> 1 cm) and subcortical infarcts and micro-hemorrhages were assessed from structural MRI scans (T1, FLAIR, and GRE sequences on 1.5T). We tested for differences between CKD and non-CKD using linear regression for WMH fraction, Fisher’s exact test for infarcts, and negative binomial regression for counts of definite micro-hemorrhages. Adjusted models controlled for age, race, sex, education, and diabetes. Results: Participant characteristics are described in Table 1. Gray matter volume was lower in CKD vs. non-CKD ppts in ROIs that are associated with cerebrovascular disease (frontal lobes) and Alzheimer’s disease (temporoparietal regions) (p<0.05). Global cortical volume was also significantly lower in CKD vs. non-CKD ppts (p<0.05). We also found higher mean WMH fraction in CKD participants (unadjusted p¼0.03, adjusted p¼0.17). Ten (9%) CKD ppts had > 1 small cortical or > 1 subcortical infarct vs. none in non-CKD (p¼0.14). Twenty-three CKD ppts had 57 definite micro-hemorrhages, compared to 9 in 3 non-CKD ppts, but this difference was notstatistically significant. Conclusions: We found significantly lower gray matter volume in ROIs associated with both AD and vascular disease and greater WMH burden in CKD vs. non-CKD ppts. Prevalence of ppts with > 1 cortical or > 1 subcortical infarct and prevalence of ppts with micro-hemorrhages were also higher in CKD vs. non-CKD ppts, although these differences were not statistically significant. These results suggest that CKD is associated with structural changes in the brain that reflect both neurodegenerative and vascular etiologies. Further sutdy is needed to understand the correlation of the structural abnormalities with cognitive function. Sponsor:NIA AG037551-01A3. P2-080
POST-STROKE COGNITION CORRELATES BETTER WITH REGIONAL BRAIN VOLUME THAN WHITE MATTER HYPERINTENSITY VOLUME
Amy Brodtmann1, Emilio Werden1, Qi Li1, Laura Bird2, David Darby3, Toby Cumming1, 1The Florey Institute for Neuroscience and Mental Health,
P499
Melbourne, Australia; 2The Florey Institute, The Florey Institute for Neuroscience and Mental Health, Melbourne, Australia; 3The Florey Institute, The Florey Institute for Neuroscience and Mental Health, Parkville, Australia. Contact e-mail: [email protected] Background: Results from several longitudinal community studies suggest that white matter lesions or hyperintensities (WMH) are associated with cognitive and functional impairment in dementia and stroke patients. Further evidence from the Framingham cohort suggests that WMH volume and total brain volume are also associated with increased risk of stroke. However, the association between WMH volume, regional brain volumes and cognition after stroke have not been studied in detail. The Cognition And Neocortical Volume After Stroke (CANVAS) study is a prospective longitudinal study looking at cognition and brain volume after stroke. We examined the WMH, hippocampal and amygdaloid volumes in the first 50 patients and correlated with tests of memory and attention. Methods: Patients were included if they had no history of cognitive decline, and were tested within 30 days of acute ischemic stroke. Patients were screened for history of cognitive Isotropic 1 mm MPRAGE images were acquired on a Siemens Trio 3T MRI scanner. Images were processed using Freesurfer V 5.1 with default settings, generating automated measures for thalami and amygdalae. Hippocampal and total brain WMH volumes were calculated via manual tracing. Regional volumes were calculated as ipsi-, contralesional and averaged. Patients completed tests of memory (Hopkins Verbal Learning Test-Revised (HVLT): total, delay, retention, and recognition z scores) and attention (CogState, detection, and identification reaction time, one back learning test (OBK) percent correct). Correlation analysis was performed for cognitive scores, WMH volume and regional volumes. Results: 50 patients aged 68.8611.6 years (mean years of education 13.364.0, NIHSS 3.863.1, days to testing 22.3) were included. Performance on the HVLT was below expected norms: mean total z-score -0.88, delayed -1.06. WMH volume was not significantly correlated with analysed cognitive measures. Hippocampal and amygdaloid volume was more strongly correlated with immediate recall and recognition memory than delayed recall - see table. Performance in OBK was significantly correlated with amygdala volume but not with hippocampal volume. Reaction times correlated most strongly with ipsilesional hippocampal volume: detection r¼-0.316, p¼0.039; identification r¼-0.390, p¼0.010. Conclusions: Memory performance is impaired in stroke patients in the first month following stroke, even in people with no history of cognitive impairment. Hippocampal and amygdaloid volumes correlated more closely than WMH with memory and attention in the early post-stroke period. Table Hippocampal volume
r-value
p-value
HVLT immediate recall HVLT recognition memory HVLT delayed recall One back learning
0.346 0.331 0.190 0.240
0.016 0.023 0.19 0.212
Amygdala volume
r-value
p-value
HVLT immediate recall HVLT recognition memory HVLT delayed recall One back learning
0.322 0.432 0.220 0.358
0.024 0.002 0.130 0.012
P2-081
COGNITIVE IMPAIRMENT IN MODERATE CHRONIC KIDNEY DISEASE: THE BRAIN IN KIDNEY DISEASE (BRINK) STUDY
Anne M. Murray1, David S. Knopman2, Rebecca C. Rossom3, Brooke Heubner4, David Tupper5, Elizabeth Amiot1, 1Minneapolis Medical Research Foundation, Minneapolis, Minnesota, United States; 2Mayo Clinic, Rochester, Minnesota, United States; 3HealthPartners, Bloomington, Minnesota, United States; 4Chronic Disease Research Group, Minneapolis, Minnesota, United States; 5Hennepin County Medical Center, Minneapolis, Minnesota, United States. Contact e-mail: [email protected]